Fragile states facing the problem of health and development. A focus on Africa.

Abstract

The recognition that better health is central in tackling poverty as well as basic in strengthening human development has led health to be at the heart of the Millennium Development Goals (MDG). Among the eight MDGs, as the expression of wide international commitment to universal development and poverty eradication, health is represented in three of them but is also strictly correlated to the achievement of extreme poverty and hunger eradication, education and gender equality goals. However, data demonstrate that health MDGs (MDG 4 reduces children mortality, MDG 5 improves maternal health and MDG 6 combats HIV/AIDS, malaria and other diseases) will hardly be reached by fragile states, a large number of them are located in Sub-Saharan Africa. Weak state institutions are the central driver of this fragility. In fragile states political institutions are unable to perform even the minimal functions supposed to be done first for their cirizens' safety and well - being, but also for the good functioning of their international system. Their institutions show their inconsistency even in inadequate resources and services allocation. In Africa, the ineffectiveness of increased public spending on health outcomes evidently reflects the several weak institutional capacities, from leakage in public spending to poor budget management. All along they are regarded as the reasons why African governments are hardly able to translate public spending into effective services because of the effect of corruption. Corruption, embedded in Africa's political economy, becomes a developmental issue that prevents the African continent from improving its health condition. “Big-time corruption” at highest levels of government begets “quiet corruption” at the frontline of public health service provision, through misconducts going beyond big monetary transactions, such as health staff absenteeism, drugs theft, counterfeiting and bribes to patients. Yet, since quiet corruption directly affects a large number of beneficiaries, it has conceivably more deeper consequences on African households.